Journal of the American Dental Association最新文献

Background: Artificial intelligence (AI) applications in dentistry are advancing rapidly, yet external validation studies are scarce. This pilot study evaluated 2 US Food and Drug Administration-cleared AI-based decision support systems for detecting caries and clinically relevant periodontal bone loss (≥ 33% or ≥ 5 mm of attachment loss) using longitudinal clinical data to establish ground truth.

Methods: A retrospective analysis of 90 patients (mean [SD] age, 61.4 [13.2] years) records was conducted at the Veterans Affairs Greater Los Angeles Health Care System in Los Angeles, California. Each case included full-mouth radiographs and standardized clinical documentation with 6 through 12 months of follow-up. Ground truth was determined through a multiphase validation protocol involving calibrated examiners and adjudication. Analyses emphasized specificity and negative predictive value (NPV) to assess diagnostic concordance.

Results: For caries detection, vendor A achieved 78.68% concordance, 80.17% specificity, and 96.92% NPV; vendor B achieved 82.43%, 83.76%, and 97.36%, respectively. For periodontal bone loss, vendor A achieved 78.47% concordance, 94.23% specificity, and 80.64% NPV; vendor B achieved 73.89%, 93.55%, and 75.20%, respectively.

Conclusions: The results of this external validation pilot study showed AI tools can reliably exclude disease and reduce false-positive results. The use of retrospective longitudinal ground truth with standardized validation protocols provides a practical template for future multisite studies.

Practical implications: AI-based decision support tools are most effective as adjunctive screening aids in dental practice. Their high specificity and NPV allow clinicians to trust negative findings, avoid unnecessary interventions, and maintain clinical oversight of positive findings requiring confirmation.

Background: The authors aimed to evaluate the effects of different finishing and polishing (FP) protocols and aging (thermocycling [TC]) on the flexural strength, microhardness, surface roughness, and Candida albicans adherence of 3-dimensional (3D)-printed and prefabricated resins for definitive restorations.

Methods: A total of 360 specimens (240 from 3D-printed resins and 120 from Tetric CAD [T] resin, Ivoclar Vivadent) were fabricated and divided into 24 groups (n = 15) on the basis of resin, FP protocol (ie, control, diamond bur, composite resin rubber, and a combination of diamond bur and composite resin rubber), and aging (with, without). The specimens were stored (37 °C for 24 hours) or thermocycled for 10,000 cycles. Specimens were tested for flexural strength (in megapascals), Vickers microhardness (in gigapascals), surface roughness (arithmetical mean height in micrometers), C albicans adhesion (logarithm of colony-forming units per milliliter), and scanning electron microscopy. Statistical analyses included analysis of variance, Tukey test, Weibull analysis, and Kruskal-Wallis test.

Results: The T resin exhibited higher flexural strength values than the 3D-printed resins (P < .01). The T resin and diamond bur FP group had the highest arithmetic mean height among all groups (P < .01). Lower microhardness values were observed for the T resin and composite resin rubber FP with aging (TC) group and the T resin and diamond bur FP with aging (TC) group than the groups without aging (P < .01). C albicans adherence was not influenced by means of the resin and FP factors.

Conclusions: Rubber polishing maintained mechanical strength and produced the smoothest surfaces in both printed and prefabricated resins but did not influence C albicans adhesion. Aging affected the prefabricated resin only, reducing its strength and microhardness.

Practical implications: Rubber polishers are recommended for FP printed or prefabricated resin materials and diamond burs should be avoided. However, if diamond burs must be used, subsequent polishing with rubber polishers can help mitigate any adverse effects.

Background: Temporomandibular disorders (TMDs) often emerge during adolescence and are associated with substantial pain burden and psychosocial distress, yet few researchers have comprehensively characterized these profiles in youth.

Methods: Adolescents (aged 10-19 years) were screened for TMDs using the validated 3 screening questions for TMDs questionnaire and categorized into TMD or non-TMD control groups. All participants (50/group) completed validated questionnaires assessing pain characteristics (Graded Chronic Pain Scale), symptom burden and headache (Symptom Questionnaire), and psychosocial functioning (Revised Child Anxiety and Depression Scale and Perceived Stress Scale). Groups were compared using t tests and χ² tests; hierarchical cluster analysis was used to identify subgroups within the TMDs sample.

Results: Adolescents with self-reported TMD symptomatology reported significantly greater pain intensity (P < .001), pain-related interference (P < .001), symptom burden (P < .001), headache frequency (P < .001), anxiety (P = .002), and depression (P < .001) than control participants. Through cluster analysis the following 3 subgroups were identified: headache cluster (high profiles), intermediate cluster (high symptom burden and pain-related interference), and no headache cluster (low profiles). Among those with TMDs, co-occurring headache (56%) was associated with significantly worse outcomes across all domains (all, P ≤ .017). No significant interaction was observed between TMDs and headache on the basis of a multiple analysis of variance (P = .054).

Conclusions: Adolescents with self-reported TMD symptomatology experienced elevated pain and psychological symptoms, with distinct symptom-based subtypes. Headache co-occurrence worsened symptoms severity.

Practical implications: Incorporating psychosocial screening and headache assessment into routine care for adolescents with TMDs may improve early identification of those at greater risk of developing pain-related disability and facilitate timely, targeted intervention.

Background: Osteoradionecrosis (ORN) is a severe complication of external beam radiation therapy or brachytherapy in patients with head and neck cancer. Traditional theories of its etiology have been unsuccessful in producing a standardized treatment protocol. The theory of radiation-induced fibrosis (RIF) proposes that radiation is responsible for the formation of reactive oxygen species, cytokine production, and constitutive phenotypic expression of myofibroblasts contributing to the development of ORN. The support of the RIF theory in the development of ORN is the basis for the pentoxifylline and tocopherol (PENTO) protocol for the prevention and management of ORN.

Types of studies reviewed: The authors searched for studies published through April 6, 2025, in the following electronic databases: PubMed, Scopus, Cochrane Library, and ScienceDirect. Peer-reviewed publications were included if they were written in the English language, studied the use of the PENTO protocol, and had "pentoxifylline," "osteoradionecrosis," and "jaw" in their title, abstract, or key words. Sixty-eight articles met the inclusion criteria, 60 of which were included in this scoping review.

Results: The authors aimed to describe the pathophysiology of RIF and determine whether the PENTO protocol is effective in the treatment and prevention of ORN of the jaws, thereby warranting further research. The results of this review suggest the PENTO protocol may provide a viable method of both prevention and management of ORN. However, further research is needed to determine the efficacy and safety of the PENTO protocol.

Conclusions and practical implications: The authors emphasized the need for a well-formulated, multidisciplinary, double-blinded, prospective, randomized clinical trial to investigate the use of the PENTO protocol in the prevention and management of ORN of the jaws. Determining the most effective PENTO regimen will maximize patient healing and minimize morbidity.

Background: Increasingly, dentists are using silver diamine fluoride (SDF) to treat caries. Reimbursement policy may play a role in clinical decision making. The authors examined safety-net dentists' knowledge, attitudes, and practices related to SDF usage.

Methods: A 55-item questionnaire was developed and administered electronically via the National Network for Oral Health Access listserv. The Consolidated Framework for Implementation Research guided questionnaire development, and the following 4 of 5 Consolidated Framework for Implementation Research domains were incorporated: the individual, the innovation, the inner clinical setting, and the outer setting. Questions focused on dentists' SDF use from personal, clinical, and policy perspectives. All items used a 5-point Likert scale (ranging from 1 [strongly disagree] through 5 [strongly agree]). Descriptive statistics were used to summarize the data.

Results: Analysis included 158 responses; the response rate was 45.9%. Only 5.7% of respondents had never used SDF, and 23.4% used it more than once per day. The most common driver of SDF use was uncooperative patients (56%). Nearly two-thirds of respondents strongly agreed or agreed that their use of SDF has increased since their state Medicaid program began reimbursing for CDT 2024: Current Dental Terminology code D1354 (application of caries arresting medicament - per tooth). Respondents reported that a reasonable reimbursement amount for code D1354 was $44 (mean [SD], $43.79 [$25.07]).

Conclusions: Medicaid reimbursement policy has some influence on dentists' clinical decision making to use SDF, but clinical factors are key drivers of or barriers to use.

Practical implications: SDF reimbursement policies can align more closely with evidence-based guidelines to support more optimal use. Dentists would use SDF more often if reimbursement policies had fewer limitations.

Background: The bidirectional relationship between periodontal disease (PD) and diabetes is well-established, although the impact of periodontal treatment on diabetes-related complications (DRCs) remains understudied. The authors explored the association between PD and DRCs in patients with type 2 diabetes mellitus (T2DM) and PD.

Methods: A matched retrospective cohort analysis was conducted using electronic health records data for patients older than 18 years who received a diagnosis of both T2DM and PD. The treatment group had at least 1 examination and prophylaxis and a corresponding International Classification of Diseases, 10th Revision diagnosis code for PD (proxy for periodontal treatment) and the control group had none. Glycated hemoglobin levels and incidence of at least 1 DRC were compared between groups over a 1-year period postintervention. E-values were used to assess how robust findings were to unmeasured confounding.

Results: After matching, each group comprised 3,559 patients. The treatment group had lower mean glycated hemoglobin (7.22% vs 7.52%; absolute difference, -0.30 percentage points; 95% CI, -0.38 to -0.22 percentage points) and lower DRC incidence (9.20% vs 14.30%; relative risk reduction, 36%; 95% CI, 23% to 46%). This reduction was consistent across most categories of sex and race and ethnicity. The E-values (1.56-3.68) suggest confounding variables would need moderate to strong associations with both exposure and outcome to negate the observed associations.

Conclusions: Among patients with T2DM and PD, periodontal treatment was associated with improved glycemic control and reduced DRC risk across sociodemographic subgroups. This consistent risk reduction suggests periodontal treatment may be widely applicable in diabetes management.

Practical implications: The study findings support recommendations to integrate regular oral health care into comprehensive diabetes management.